Why Pay Privately For Your Psychotherapy?

Today, most major health insurance plans offer some form of mental health coverage as part of the requirements of the Affordable Care Act. This is a good thing and means that most people will at least have some access to professional mental health care, many possibly for the first time ever.

It is important to know the rules under which insurance companies agree to provide you with mental health coverage. Full knowledge of this includes both the benefits and drawbacks to the coverage. The benefits, of course, are that after you pay your deductible and copayments, the insurance will pay for some sessions with some therapists.

The drawbacks to using insurance to help pay for your psychotherapy may include:

Limits to your Privacy

Typically, insurance companies require that your therapist provide and share with them a diagnosis for your condition in order to authorize the session. This diagnosis will come from the Diagnostic and Statistical Manual version 5 (DSM 5) which contains all of the psychiatric diagnosis currently recognized. Once this information has been provided to them, the therapist and patient have very limited power over how the insurance company will use this information.

While the insurance company does have legal and ethical privacy standards that they are required to uphold, the laws are unclear and it is hard to know what becomes of the information. Some more severe diagnosis such as Major Depressive Disorder and others have been known to make purchasing life insurance difficult or impossible and also to in some cases impact security screenings and some forms of employment.

Insurance companies also periodically choose to audit the notes of therapists. This is not designed to impose on your privacy but rather to ensure that the therapist is keeping notes and following procedures in accordance with the requirements of the insurance carrier. While it is not meant to be a violation of your privacy, it certainly can feel like that.

Limits to your Sessions

Insurance companies are in the business of making money. As such, keeping their costs down is a primary goal. The fewer sessions that they pay for, the lower their costs. This can set up a dynamic in which obstacles to treatment are part of the system. Cumbersome authorizations, complicated deductibles and limits to the number of sessions that you can attend are often part of the picture

Limits to Depth of your Therapy

With a limited number of sessions available and with a specific diagnostic focus required by the insurance company, the scope of the therapy must also often be limited. This may seem like a good thing as it is designed to keep the therapy “on track” and “solution-focused”. But it also means that often very important issues go unexplored. It can get in the way of the therapist being able to over time identify and address with you recurring dynamics that arise in your life and seek to find paths of improvement and growth. The brief and solution-focused approach may also mean that areas of meaningful personal growth and healing are sacrificed in favor of quicker “fixes”

The benefits of paying privately for your psychotherapy may include:

Deeper and More Lasting Change

More than any other factor, it is the quality of the rapport, relationship and level of trust between the patient and therapist that is the single biggest factor in how successful the therapy will be. More than level of education, type of therapy pursued or presence or absence of medication. Coming to deeply trust someone after five or ten combined hours of knowing them is not always likely. The value of putting in the time in the early phases of therapy to develop trust and take the time to let issues emerge in their own time may mean that more impactful change and growth can take root in later phases of the therapy.

Greater Understanding

Issues that bring people to therapy are complex and layered. Brief, symptom or solution focused treatments do not usually address the underlying issues. As a result, problematic patterns of thinking, relationships, and mood states can be more likely to return because underlying issues have been not allowed to be more fully realized, understood and addressed. When you pay privately for therapy, the course of therapy is dictated by you and your therapist alone. You are free to explore and work through issues in depth making related symptoms less likely to return when the therapy ends.

Greater Value

Like many things in life, we may give more emotional and psychological value to therapy when we pay for it. Budgeting and paying for therapy out of your own pocket gives the relationship more weight and personal investment. When we are personally invested in something, we tend to give our full selves to the hard work and make better outcomes more likely. Working through the practicalities and psychological issues of paying for therapy can be very healthy for the process as it often raises the issues of self-worth, priorities, perception of others etc. and can increase the depth and effectiveness of therapy.

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